La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores que viven en la comunidad.

OBJETIVO: Determinar la asociación entre mala autopercepción de salud oral y fragilidad en personas mayores. Material y métodos. Estudio transversal en personas mayores de la Ciudad de México. La autopercepción de salud oral se midió con el Geriatric/General Oral Health Assessment Index (GOHAI) y la fragilidad con el fenotipo de Fried y colaboradores. RESULTADOS: 1 173 personas mayores, media de edad de 66.0 (5.7) años, mujeres 46.1% (n=541). La media (IC95%) de GOHAI-Sp fue de 49.2 (48.9-49.6). El 9.2% (n=108) presentaron fragilidad, 59.9% (n=703) prefrágil y 30.9% (n=362) no frágiles. La fuerza de asociación (RM) para mala autopercepción de salud oral y frágil fue RM 2.4 (IC95% 1.5,3.7) y RM ajustada RM 1.7 (IC95% 1.1,2.8), referencia no frágil. No existe asociación significativa para la mala autopercepción de salud oral y prefrágil. Conclusión. La mala autopercepción de salud oral se asocia con la presencia de fragilidad en personas mayores.

Oral health condition and development of frailty over a 12-month period in community-dwelling older adults.

BACKGROUND: To determine the association between oral health condition and development of frailty over a 12-month period in community-dwelling older adults. METHODS: Population-based, case-cohort study derived from the Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults (COSFOMA) study, including data from years 2015 and 2016. Using latent class analysis, we determined the oral health condition of older adults with teeth (t0), i.e., functional teeth, presence of coronal caries, root caries, periodontal disease, dental calculus, dental biofilm, root remains, xerostomia, and need for dental prosthesis. Edentulous was considered as a separate class. Criteria of the Frailty Phenotype (t1) by Fried et al. were used: weight loss, self-report of exhaustion, walking speed, decreased muscle strength, and low physical activity. The presence of three or more criteria indicated a frail condition. The strength of the association (odds ratio, OR) between oral health condition and development of frailty was estimated through bivariate analysis. Multiple logistic regression was used to adjust for the other variables of study: sociodemographic data (sex, age, marital status, level of education, paid work activity, and living alone), comorbidities, cognitive impairment, depressive symptoms, nutritional status, and use of oral health services. RESULTS: 663 non-frail older adults were evaluated, with a mean age of 68.1 years (SD ± 6.1), of whom 55.7% were women. In t0, a three-class model with an acceptable value was obtained (entropy = 0.796). The study participants were classified as: edentulous persons (6.9%); Class 1 = Acceptable oral health (57.9%); Class 2 = Somewhat acceptable oral health (13.9%); and Class 3 = Poor oral health (21.3%). In t1, 18.0% (n = 97) of participants developed frailty. Using Acceptable oral health (Class 1) as a reference, we observed that older adults with edentulism (OR 4.1, OR adjusted 2.3) and Poor oral health (OR 2.4, OR adjusted 2.2) were at an increased risk of developing frailty compared to those with Acceptable oral health. CONCLUSION: Older adults with edentulism and poor oral health had an increased risk of developing frailty over a 12-month period.

Self-perception of oral health in older adults from Mexico City / Autopercepción de la salud oral en adultos mayores de la Ciudad de México

Background: Quality of life related to oral health is assessed through the individual's self-perceived oral health (SPOH). The objective is to determine SPOH in relation to socio-demographic and health characteristics in older adults beneficiaries from the Instituto Mexicano del Seguro Social (IMSS) in Mexico City. Methods: Cross-sectional study. We used data collection with questionnaire and assessment scales related to socio-demographic, health and dependency variables, as well as the visit to the dentist, the use of removable dental prostheses and SPOH. The self-perception means (Geriatric/General Oral Health Assessment Index-GOHAI) were calculated, and we used Student's t, ANOVA and Bonferroni post hoc tests. Results: 60.5% were women; the average age of population was 68.23 ± 7.0. GOHAI total mean was 48.07 (48.05-48.08). Compared to their counterparts, people with the next features showed marked improvement in SPOH: of 60-69 years of age, separated or divorced, ≥ 7 years of study, paid work, living alone, no smoking, drinking alcohol, with a good health perception, low weight, no cognitive impairment, no depression, no anxiety, no comorbidity, consumption < 5 drugs, with limitations in basic activities, without limitations in instrumental activities, who did not visit the dentist and who did not use removable prosthesis. Conclusion: The concept of quality of life essentially incorporates the SPOH as a need in the evaluation of health outcomes.

Introducción: la calidad de vida relacionada con la salud oral se evalúa a partir de la autopercepción de la salud oral (APSO) del individuo. El objetivo es determinar la APSO con respecto a las características sociodemográficas y de salud en adultos mayores derechohabientes del Instituto Mexicano del Seguro Social (IMSS) de la Ciudad de México. Métodos: estudio transversal con datos sociodemográficos, de salud, de dependencia, visita al dentista, uso de prótesis dental removible y APSO. Se calcularon las medias de autopercepción (Geriatric/General Oral Health Assessment Index: GOHAI) y se usaron las pruebas t de Student, ANOVA y post hoc Bonferroni. Resultados: el 60.5% fueron mujeres. La edad promedio de la población fue 68.23 ± 7.0. La media (IC) del GOHAI total fue 48.07 (48.05-48.08). Comparados con sus contrapartes, hubo mejor autopercepción de la salud oral en los individuos del grupo de 60-69 años, separados o divorciados, ≥ 7 años de estudio, con trabajo remunerado, que vivían solos, no fumaban, sí bebían alcohol, tenían buena percepción de salud, bajo peso, sin deterioro cognitivo, ni depresión, ni ansiedad, ni comorbilidades, que consumían < 5 fármacos, con limitaciones en actividades básicas, sin limitaciones en actividades instrumentales, que no visitaban al dentista y no usaban prótesis removible. Conclusión: el concepto de calidad de vida incorpora esencialmente la APSO del paciente como una necesidad en la evaluación de resultados en salud.

Frailty in community-dwelling older adults: association with adverse outcomes.

BACKGROUND: The study of frailty is important to identify the additional needs of medical long-term care and prevent adverse outcomes in community dwelling older adults. This study aimed to determine the prevalence of frailty and its association with adverse outcomes in community dwelling older adults. METHODS: A cross-sectional study was carried out from April to September 2014. The population sample was 1,252 older adults (≥60 years) who were beneficiaries of the Mexican Institute of Social Security (IMSS) in Mexico City. Data were derived from the database of the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA). Operationalization of the phenotype of frailty was performed using the criteria of Fried et al (weight loss, self-report of exhaustion, low physical activity, slow gait, and weakness). Adverse outcomes studied were limitation in basic activities of daily living (ADLs), falls and admission to emergency services in the previous year, and low quality of life (WHOQOL-OLD). RESULTS: Frailty was identified in 20.6% (n=258), pre-frailty in 57.6% (n=721), and not frail in 21.8% (n=273). The association between frailty and limitations in ADL was odds ratio (OR) =2.3 (95% confidence interval [CI] 1.7-3.2) and adjusted OR =1.7 (95% CI 1.2-2.4); falls OR =1.6 (95% CI 1.2-2.1) and adjusted OR =1.4 (95% CI 1.0-1.9); admission to emergency services OR =1.9 (95% CI 1.1-3.1) and adjusted OR =1.9 (95% CI 1.1-3.4); low quality of life OR =3.4 (95% CI 2.6-4.6) and adjusted OR =2.1 (95% CI 1.5-2.9). CONCLUSION: Approximately 2 out of 10 older adults demonstrate frailty. This is associated with limitations in ADL, falls, and admission to emergency rooms during the previous year as well as low quality of life.

[Quality of life related to oral health in older people. Evaluation instruments]. / Calidad de vida relacionada con la salud oral en adultos mayores. Instrumentos de evaluación.

Given that life expectancy has increased considerably due to medical and technological advances, in recent years researchers have decided to meet the specific needs of the elderly in order to provide them better health care, in view of the fact that the aging process generates physical, biological and social changes. On the basis of this knowledge it becomes evident the impact of general health and oral health quality of life, which usually has a negative impact. Consequently, the aim of this work is to provide researchers and clinicians a review of the instruments that have been used for evaluation of the quality of life related to oral health. These instruments are the Oral Health Impact Profile (OHIP), the Oral Impacts on Daily Performances (OIDP) and the General Oral Health Assessment Index (GOHAI). Supplementary to the explanation of these instruments, our aim is to describe their structure, assessment, validation and application in studies performed on elderly Mexicans. In addition to this, we review some of the reports that compare the usefulness of those instruments.

Dado que ha habido un aumento en la expectativa de vida gracias a los avances médicos y tecnológicos, desde hace ya algunos años los investigadores se han propuesto conocer las necesidades de los adultos mayores con el fin de ofrecerles una mejor atención en salud, puesto que el proceso de envejecimiento genera cambios físicos, biológicos y sociales. A partir de este conocimiento se hace evidente la repercusión del estado de salud general y oral en la calidad de vida, lo cual tiene un impacto que, por lo general, es negativo. Por lo tanto, el objetivo de este trabajo es brindar tanto a investigadores como a clínicos una revisión de los instrumentos que han sido más utilizados para la evaluación de la calidad de vida relacionada con la salud oral (el Oral Health Impact Profile [OHIP], el Oral Impacts on Daily Performances [OIDP] y el General Oral Health Assessment Index [GOHAI]), su estructura, evaluación, validación y aplicación en investigaciones llevadas a cabo en adultos mayores mexicanos. Asimismo, se revisan muchos de los reportes en los que se compara la utilidad de los instrumentos mencionados.